Implementation Of Framework Research Articles

Tracing the Success of QRIS Policy Implementation in Surabaya City’s Parking Levy System

This research explores the effectiveness of the Surabaya City Government’s policy on parking levy payments via the Quick Response Code Indonesian Standard (QRIS). The study aims to analyze the policy’s success in increasing Regional Original Income (Pendapatan Asli Daerah or PAD) and enhancing community welfare by improving the payment experience for parking users and supporting efficient management by parking attendants. Using Van Meter and Van Horn’s policy implementation framework, which includes six critical factors—policy standards and objectives, resource allocation, characteristics of implementing organizations, inter-organizational communication, implementer disposition, and socio-political and economic environment—the study evaluates both the facilitating and hindering elements of the policy. A qualitative descriptive methodology was employed, with data gathered through literature reviews, field observations, and structured interviews with key stakeholders, including government officials, parking service providers, and users. Analysis revealed that QRIS implementation has been beneficial in promoting transparency and efficiency in revenue collection, supporting PAD growth. However, challenges such as varying levels of digital literacy among users, limited internet access in certain areas, and reluctance among some parking attendants to adopt digital systems were identified as barriers to optimal implementation. Key findings suggest that the policy’s long-term success hinges on consistent inter-agency coordination, community engagement initiatives to raise digital payment awareness, and ongoing training for parking attendants to improve digital proficiency. The study concludes that achieving sustainable success in implementing non-cash transactions for parking levies requires a holistic approach, integrating community awareness, inter-organizational support, and policy adaptability. This research offers valuable insights for policymakers seeking to improve public service delivery through digital transactions. It highlights the importance of adaptive management in fostering community welfare alongside regional revenue growth.

"It's Like Making Reflective Practice More of the Heart of Who We Are": An Exploration of Facilitators and Barriers to Implementing Reflective Supervision in State Pre-K.

High-quality supervision for teachers in early care and education (ECE) is essential for building positive teacher-child relationships and enhancing ECE program quality, which in turn promotes healthy social-emotional and academic development in young children. Reflective supervision (RS) is a process-oriented and relationship-centered supervisory approach that has growing empirical evidence supporting its use. As the evidence base for RS continues to expand, and early childhood-serving settings-including ECE-increasingly consider this approach, understanding whether RS is likely to be routinely used in ECE settings and what helps or hinders use of this approach is critically important. Thus, the aims of this study were to assess the feasibility, acceptability, and appropriateness of RS in state-funded pre-Kindergarten (state pre-K) programs, as well as delineate the implementation determinants that either advanced or challenged the use of RS in state pre-K. This study was informed and guided by the updated Consolidated Framework for Implementation Research (CFIR) and the CFIR Outcomes Addendum. Participants included 11 state pre-K program supervisors who had been trained in RS. Participants completed brief measures of feasibility, acceptability, and appropriateness of RS, and semi-structured interviews. Descriptive analyses of quantitative measures revealed that participants perceived RS as feasible to implement in their programs, highly acceptable, and highly appropriate, thereby suggesting that RS is likely to be implemented successfully in this setting. Qualitative data obtained from interviews and coded using the updated CFIR lent greater nuance to these results by specifying the facilitators and barriers affecting implementation. All participants reported great need for RS at the supervisor, teacher, and child/family level, and identified numerous other facilitating factors within four CFIR domains (i.e., Innovation, Outer Setting, Inner Setting, and Individuals), ranging from the relative advantage of RS to individual supervisor motivation and capability. Participants also cited barriers to using RS, most notably staffing difficulties, competing demands, and lack of policy and leadership support. Through theory-driven implementation frameworks applied to a real-world ECE setting, these findings extend prior research suggesting that RS may be an effective supervisory approach by highlighting the contextual factors that make RS more or less likely to be adopted, used, and sustained in state pre-K.

Implementation of Cognitive (Neuropsychological) Interventions for Older Adults in Clinical or Community Settings: A Scoping Review.

Despite compelling evidence that cognitive interventions for older adults improve cognition, mood, and everyday function, few are implemented in clinical or community practice. This scoping review aims to understand the implementation frameworks and methods used and their contribution to implementation success of cognitive interventions for older adults. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews (PRISMA-ScR), and searched CINAHL, EMBASE, MEDLINE, and PSYCINFO databases, using terms related to cognitive interventions, implementation, and older adults. This resulted in 5002 studies, of which 29 were included following an iterative process. Most studies reported on implementation of cognitive stimulation for people with dementia. Only four studies used formal implementation frameworks, with three using RE-AIM, and one a process evaluation using complexity theory. The most frequently addressed implementation concepts were Acceptability, Feasibility, and Effectiveness, while Cost, Cost-Effectiveness, and Maintenance were rarely reported. Solutions to common barriers included the importance of good stakeholder relationships and engagement, a manualised intervention flexible enough to adapt to the context, and ensuring facilitators were well-trained, confident, and enthusiastic.

Design and implementation of VGD6-NET framework for waste segregation using 3-tier convolutional neural networks

Design and implementation of VGD6-NET framework for waste segregation using 3-tier convolutional neural networks

Non-small cell lung cancer detection through knowledge distillation approach with teaching assistant.

Non-small cell lung cancer (NSCLC) exhibits a comparatively slower rate of metastasis in contrast to small cell lung cancer, contributing to approximately 85% of the global patient population. In this work, leveraging CT scan images, we deploy a knowledge distillation technique within teaching assistant (TA) and student frameworks for NSCLC classification. We employed various deep learning models, CNN, VGG19, ResNet152v2, Swin, CCT, and ViT, and assigned roles as teacher, teaching assistant and student. Evaluation underscores exceptional model performance in performance metrics achieved via cost-sensitive learning and precise hyperparameter (alpha and temperature) fine-tuning, highlighting the model's efficiency in lung cancer tumor prediction and classification. The applied TA (ResNet152) and student (CNN) models achieved 90.99% and 94.53% test accuracies, respectively, with optimal hyperparameters (alpha = 0.7 and temperature = 7). The implementation of the TA framework improves the overall performance of the student model. After obtaining Shapley values, explainable AI is applied with a partition explainer to check each class's contribution, further enhancing the transparency of the implemented deep learning techniques. Finally, a web application designed to make it user-friendly and classify lung types in recently captured images. The execution of the three-stage knowledge distillation technique proved efficient with significantly reduced trainable parameters and training time applicable for memory-constrained edge devices.

Clinical Decision Support to Increase Emergency Department Naloxone Coprescribing: Implementation Report.

Coprescribing naloxone with opioid analgesics is a Centers for Disease Control and Prevention (CDC) best practice to mitigate the risk of fatal opioid overdose, yet coprescription by emergency medicine clinicians is rare, occurring less than 5% of the time it is indicated. Clinical decision support (CDS) has been associated with increased naloxone prescribing; however, key CDS design characteristics and pragmatic outcome measures necessary to understand replicability and effectiveness have not been reported. This study aimed to rigorously evaluate and quantify the impact of CDS designed to improve emergency department (ED) naloxone coprescribing. We hypothesized CDS would increase naloxone coprescribing and the number of naloxone prescriptions filled by patients discharged from EDs in a large health care system. Following user-centered design principles, we designed and implemented a fully automated, interruptive, electronic health record-based CDS to nudge clinicians to coprescribe naloxone with high-risk opioid prescriptions. "High-risk" opioid prescriptions were defined as any opioid analgesic prescription ≥90 total morphine milligram equivalents per day or for patients with a prior diagnosis of opioid use disorder or opioid overdose. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to evaluate pragmatic CDS outcomes of reach, effectiveness, adoption, implementation, and maintenance. Effectiveness was the primary outcome of interest and was assessed by (1) constructing a Bayesian structural time-series model of the number of ED visits with naloxone coprescriptions before and after CDS implementation and (2) calculating the percentage of naloxone prescriptions associated with CDS that were filled at an outpatient pharmacy. Mann-Kendall tests were used to evaluate longitudinal trends in CDS adoption. All outcomes were analyzed in R (version 4.2.2; R Core Team). Between November 2019 and July 2023, there were 1,994,994 ED visits. CDS reached clinicians in 0.83% (16,566/1,994,994) of all visits and 15.99% (16,566/103,606) of ED visits where an opioid was prescribed at discharge. Clinicians adopted CDS, coprescribing naloxone in 34.36% (6613/19,246) of alerts. CDS was effective, increasing naloxone coprescribing from baseline by 18.1 (95% CI 17.9-18.3) coprescriptions per week or 2,327% (95% CI 3390-3490). Patients filled 43.80% (1989/4541) of naloxone coprescriptions. The CDS was implemented simultaneously at every ED and no adaptations were made to CDS postimplementation. CDS was maintained beyond the study period and maintained its effect, with adoption increasing over time (τ=0.454; P<.001). Our findings advance the evidence that electronic health record-based CDS increases the number of naloxone coprescriptions and improves the distribution of naloxone. Our time series analysis controls for secular trends and strongly suggests that minimally interruptive CDS significantly improves process outcomes.

Harmonizing data across the accelerating colorectal cancer screening and follow-up through implementation science (ACCSIS) program to enhance data quality and promote data sharing

BackgroundThe purpose of the Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) Program, a Cancer Moonshot℠ Initiative, is to support research to build the evidence base on multilevel interventions that increase rates of colorectal cancer screening, follow-up, and referral to care to address disparities in colorectal cancer screening. The National Cancer Institute funded eight Research Projects to implement multilevel interventions to improve colorectal cancer screening among communities who traditionally have been medically underserved. To analyze the impact of ACCSIS across Research Projects, the consortium developed a set of common data elements. The purpose of this paper is to describe the process of developing the common data elements to facilitate analysis of ACCSIS data as well as support and inform implementation science research studies.MethodsThe ACCSIS Data, Design, and Analysis Work Group was tasked with designing common data elements through a review of existing data collection instruments, examination of data elements proposed by the ACCSIS Research Projects, and deliberations on the data required to compare across the Research Projects. ACCSIS Consortium members drafted, revised, and finalized a common data elements document consisting of variables to collect and surveys to administer to evaluate ACCSIS implementation activities and outcomes in a standardized manner across the Research Projects.ResultsThe ACCSIS Consortium decided to collect the following categories of common data elements: characteristics across multiple levels of the multicomponent interventions, implementation climate, and determinants; interventions and strategies; implementation outcome constructs and definitions; colorectal cancer screening episodes (screening, diagnostic testing follow-up, cancer detection, and cancer treatment); and cost measures. To assess implementation climate, the consortium prioritized constructs from five domains of the Consolidated Framework for Implementation Research.ConclusionsThe ACCSIS common data elements offer a set of harmonization data for future implementation efforts. The consortium is conducting a systematic assessment using both quantitative and qualitative approaches to assess data quality and approaches to improve and sustain data collection. Lessons learned from these ongoing activities will offer additional insights to tailor the ACCSIS common data elements and support efforts to increase colorectal cancer screening for populations experiencing disparities.

Digital Contact Tracing Implementation Among Leaders and Health Care Workers in a Pediatric Hospital During the COVID-19 Pandemic: Qualitative Interview Study.

Health systems had to rapidly implement infection control strategies to sustain their workforces during the COVID-19 pandemic. Various outbreak response tools, such as digital contact tracing (DCT), have been developed to monitor exposures and symptoms of health care workers (HCWs). Limited research evidence exists on the experiences with these technologies and the impacts of DCT innovations from the perspective of stakeholders in health care environments. This study aims to identify the factors influencing the adoption of DCT, highlight variations in perspectives across 3 key stakeholder groups concerning the impact of DCT, and provide benchmarking evidence for future pandemic preparedness. Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we conducted an exploratory qualitative study to investigate the implementation and impact of DCT at the Children's Hospital of Eastern Ontario between December 2022 and April 2023. We conducted 21 semistructured interviews with key stakeholders, including health care administrators (6/21, 29%), occupational health and safety specialists (8/21, 38%), and HCWs (7/21, 33%). Stakeholders were asked about the factors influencing engagement with the DCT tool, organizational-level uptake, the implementation process, long-term use and sustainability of DCT, and unintended consequences. Verbatim transcripts were subject to thematic analysis using NVivo (QSR International). The implementation of DCT was viable and well received. End users indicated that their engagement with the DCT tool was facilitated by its perceived ease of use and the ability to gain awareness of probable COVID-19 exposures; however, risk assessment consequences and access concerns were reported as barriers (reach). Participants commonly agreed that the DCT technology had a positive influence on the hospital's capacity to meet the demands of COVID-19 (effectiveness). Implementors and occupational specialists referred to negative staffing impacts and the loss of nuanced information as unintended consequences (effectiveness). Safety-focused communication strategies and having a DCT tool that was human-centered were crucial factors driving staff adoption of the technology. Conversely, adoption was challenged by the misaligned delivery of the DCT tool with HCWs' standard practices, alongside the evolving perceived threat of COVID-19. Stakeholders collectively agreed on the viability of DCT and its applicability to infectious disease practices (maintenance). Hospital stakeholders were highly satisfied with DCT technology and it was perceived as feasible, efficient, and having a positive impact on organizational safety. Challenges related to the alignment and delivery of DCT, alongside the evolving perspectives on COVID-19, posed obstacles to continued adoption by HCWs. Our findings contribute to evidence-based practices and present benchmarks that can inform preparedness for future pandemics and infectious disease outbreaks and help other organizations implement similar technologies.

The UPFRONT project: tailored implementation and evaluation of a patient decision aid to support shared decision-making about management of symptomatic uterine fibroids

ObjectiveTo evaluate implementation of a patient decision aid for symptomatic uterine fibroid management to improve shared decision-making at five clinical settings across the United States.MethodsWe used a type 3 hybrid effectiveness-implementation stepped-wedge design and the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) planning and evaluation framework. We conducted clinician training, monthly reach tracking with feedback to site clinical leads, patient and clinician surveys, and visit audio-recordings. Implementation strategies included assessment of organizational readiness for shared decision-making, synchronous clinician training, audit and feedback of decision aid reach, and access to multiple decision aid formats. Outcomes and analyses included patient-level reach, clinician-level adoption, and associations of patient-reported decision aid exposure (as treated) and setting-level implementation (intention-to-treat) with patient-reported (collaboRATE measure) and observed (OPTION-5 measure) shared decision-making. We also designed and assessed setting-level plans for sustainability and other factors impacting sustained decision aid use.ResultsThe decision aid was adopted by 72 of the 74 eligible gynecologists (97%) and reached 2553 patients across five settings. CollaboRATE scores improved among patients who reported receiving the decision aid (as-treated analysis, 69% vs. 59%; OR 1.6, 95% CI 1.16–2.27). CollaboRATE scores remained consistent before and after setting-level decision aid implementation (intention-to-treat analysis, 64% vs. 63%; OR 0.86, 95% CI 0.61–1.22). Participants would prefer to receive a decision aid at multiple time points (91.9% before the visit, 90.7% during the visit, 86.5% after the visit). Shared decision-making experiences did not improve when comparing pre vs. post-implementation collaboRATE scores across included settings (intention-to-treat, 64% vs. 63%; OR 0.86, 95% CI 0.61–1.22).ConclusionWhen patients with symptomatic uterine fibroids are given decision aids, they report higher shared decision-making scores. However, the differences we observed between the as-treated and intention-to-treat results suggest that unaddressed implementation challenges continue to limit the extent to which patients receive decision aids and likely hinder their overall impact. Future efforts to implement decision aids should explore enhancing their integration into clinical workflows and standard operating procedures, supported by organizational incentives that prioritize shared decision-making.Trial registrationClinicalTrials.gov NCT03985449; registered 6 June 2019.

Vaccine equity implementation: exploring factors influencing COVID-19 vaccine delivery in the Philippines from an equity lens

BackgroundDuring the early phase of the COVID-19 vaccine rollout, low and middle-income countries (LMICs) were facing challenges in achieving equitable vaccine delivery. Few studies have contextualized global vaccine distributive injustice into national-specific contexts to understand its impact on vaccine delivery from an equity perspective. We aimed to investigate factors influencing equitable COVID-19 vaccine delivery in the Philippines and to provide recommendations to enhance equitable vaccine delivery in LMICs to prepare for future health emergencies.MethodsThe Health Equity Implementation Framework was employed to guide this qualitative study. We recruited participants using purposeful and snowballing sampling strategies. Semi-structured interviews were conducted with participants in person, online, or over the phone. A reflective thematic analysis approach was employed to analyze data.ResultsWe recruited 38 participants including seven high-level stakeholders from the public and private sectors, 14 health workers, and 17 community members in the province of Negros Occidental, Philippines. Equitable delivery of COVID-19 vaccines was influenced by an interplay of multiple factors operating in different domains. Contextually, the rapidly evolving nature of the COVID-19 virus, ongoing scientific advancements, and international negotiations directed national-level vaccine policies. Political commitment and support were recognized as crucial drivers for successful vaccine delivery, with a strong emphasis on health information framing and communication and adherence to human rights principles. The vulnerability of the health system significantly impacted the timely and effective distribution of vaccines. Furthermore, the geographical characteristics of the Philippines presented unique logistical challenges to vaccine delivery. At the recipient domain, individual perceptions of vaccines, shaped by their socioeconomic status, exposure to (mis)information, social influence, and entrenched religious beliefs, played a major role in their vaccine decisions and thus vaccine coverage regionally. Additionally, vaccine characteristics and operational challenges related to its distribution also impacted fair allocation.ConclusionsThe findings highlight the urgent need for LMICs to strengthen their health system resilience and sustainability and use multilevel strategies to build public trust to improve vaccine uptake and coverage. Moreover, each LMIC must be attentive to its unique contextual factors to develop tailored implementation strategies to promote equitable vaccine distribution.

National STEM Education Framework: Teachers’ Perspectives on the 2015-2022 Curriculum Cycle

Throughout the world, nations are busy investing in Science, Technology, Engineering and Mathematics (STEM) to prepare innovative minds that can spearhead the development and sustainable growth of their economies. Zimbabwe’s participation in the global economy is premised on the preference for STEM education system. The introduction of the Competence-Based Curriculum (CBC) in Zimbabwe meant a shift in the general aims and objectives of the education system. The transformation meant a move from an academic oriented and content-focused curriculum to one that is skills-based, giving prominence to continuous assessment over final examinations. To explore classroom practitioners’ perceptions of the first cycle of the CBC, 20 purposively selected STEM teachers participated in the study. A qualitative research approach and case study design were adopted as study methodology. Thematically analysed data were collected through focus group interviews with participants. The study focused on support systems available for STEM education in secondary schools and how the absence of the national framework affects its implementation. The study found that there were limited support systems for STEM education as some schools did not have adequate facilities and equipment such as science laboratories, apparatus, science consumables, computer laboratories, computer hardware and software among others. It came out from the study that the absence of national framework had negative effect on the implementation of STEM education in secondary schools. The study concluded that though the secondary schools experienced constraints in implementing STEM education there were noticeable pockets of good practices in some schools, for example, learners graduating with competences for life skills. The study recommended that the schools should engage stakeholders for support in provision of required resources. The Ministry of Primary and Secondary Education should expedite the development of a national framework for the effective implementation of STEM education.

Концептуальні рамки управління борговим фінансуванням публічних бюджетів

Introduction. Overcoming the consequences of the COVID-19 pandemic and full-scale Russian aggression against Ukraine caused the destruction of a stable system of managing financial flows not only in our country, but also in many states. Market and regulatory mechanisms for mobilization and the use of financial resources were undermined. Fiscal consolidation measures were changed in favor of expansion. The need to increase the resource base on the basis of state debt has intensified. The use of standardized approaches in the field of fiscal policy did not make it possible to limit risks under new conditions. The task of implementing new conceptual approaches to the management of public budget financing based on the use of debt instruments has arisen. Problem Statement. An increase in debt financing of public budgets helps to expand the volume of resources for the implementation of state plans. At the same time, the pressure on the financial system is growing, which requires making significant changes to the formation of the structure of debt instruments, their placement on domestic and foreign financial markets, attraction of resources on preferential terms from foreign partners, fulfillment of repayment and servicing obligations, refinancing and restructuring of loans. Determining rational management decisions on these issues involves the development of a conceptual framework for public debt financing. The purpose is to study the formation of a conceptual framework for managing debt financing of public budgets and their use in the practice of public administration. Methods. Research methods are used: historical, logical, abstraction, description, generalization, comparison, grouping, analysis and synthesis. Results. The adoption of the debt framework guides the definition of debt strategy, debt management goals, indicators of its volume and structure, debt management tasks, as well as mechanisms and tools for their implementation. The debt strategy reflects the orientation of the debt policy, the goals of public debt management for long and medium-term periods, its indicators, the use of tools and mechanisms for achieving the adopted goals, the formation of the debt portfolio for the specified terms, the classification of risks of government debt management taking into account their impact on the performance of state budget, the application of refinancing and restructuring mechanisms for state liabilities. Conclusions. The conceptual framework for managing debt financing of public budget is an important guiding document aimed at taking into account the conditions for placing debt obligations among investors (state institutions, non-state depositors, non-residents), access to international financial markets, cooperation with international organizations and financial institutions, acceptance of debt portfolio (the structure of state budget financing), built according to types of debt instruments, sources of financing, currencies of loan repayment and servicing, repayment terms, loan servicing rates and debt refinancing. The development and implementation of the conceptual framework for the management of public debt transactions is important for Ukraine. In the conditions of overcoming the consequences of the war and post-war reconstruction, it is necessary to apply a comprehensive approach to the formation, distribution and use of resources raised on the basis of the use of public debt instruments.

Building Engagement-Capable Environments for Health System Transformation: Development and Early Implementation of a Capability Framework for Patient, Family and Caregiver Engagement in Ontario Health Teams.

Despite widespread calls to involve patients, families and caregivers (PFCs) as partners at all levels of health system planning and design, there is unevenness in how engagement efforts are supported across these settings. The concept of 'engagement-capable environments' offers a way forward to uncover the key requirements for sustainable, high-quality engagement, but more work is needed to identify the specific competencies required to create these environments. We addressed this gap by developing a capability framework for Ontario Health Teams (OHTs), a newly established structure for planning, designing, organizing and delivering care in Ontario, Canada. The framework was co-developed by a Working Group of OHT staff and leaders, PFC partners, researchers and government personnel. Project activities occurred over four phases: (1) planning, (2) evidence review and surveying of intended users to identify key competencies, (3) framework design and (4) implementation. An evidence review identified more than 90 potential competencies for this work. These results were contextualized and expanded through a survey of OHT stakeholders to brainstorm potential competencies, supports and enablers for engagement. Surveys were completed by 69 individuals; 689 knowledge and skill competency statements, 462 attitude and behaviour competency statements and 250 supports and enablers were brainstormed. The statements were analysed and organized into initial competency categories, which were reviewed, discussed and iteratively refined by Working Group members and through broader consultations with the OHT community. The final framework includes six competency domains and four support and enabler domains, each with sub-domain elements, mapped across a three-stage maturity model. The framework has been disseminated across OHTs, and its adoption and implementation are now requirements within OHT agreements. The framework combines a strong conceptual foundation with actionable elements informed by the literature and consultations with the intended users of the framework. Although developed for OHTs, the framework should be broadly applicable to other health system organizations seeking similar health system transformation goals. Patient, family and caregiver partners were involved at all stages and in all aspects of the work. As end users of the framework, their perspectives, knowledge and opinions were critical.

Implementation of a High-Reliability Organization Framework in a Large Integrated Health Care System: A Pre-Post Quasi-Experimental Quality Improvement Project.

The purpose of this quality improvement (QI) project was to evaluate outcomes across Veterans Health Administration (VHA) hospital facilities engaged in an enterprise-wide implementation of a high-reliability organization (HRO) framework. This QI project relied on primary data drawn from 139 facilities nationwide from 2019 to 2023. Data sources included the All Employee Survey Patient Safety Culture (PSC) Module and patient safety reporting data derived from the Joint Patient Safety Reporting system. The project design applied a pre-post quasi-experimental design that examined within-cohort changes at pre-intervention, intervention, and 2 post-intervention follow-up timepoints. HRO interventions included a combination of training, leadership coaching, site assessments, and experiential learning. HRO interventions were initiated at 18 facilities beginning in 2019 (Cohort 1), 54 facilities in 2020 (Cohort 2), and 67 facilities in 2021 (Cohort 3). For between-cohort analyses, the relative degree of change within Cohort 1 sites was compared with all other sites. There were broad positive within-group trends for PSC scores across all sites, and domain-specific between-group differences in PSC Dimension 2-Risk Identification and Just Culture-and Dimension 4-Error Transparency and Risk Mitigation. For patient safety reporting, total events reported, and close calls increased for Cohort 1. The ratio of close calls to adverse events also increased for both Cohort 1 and all other VHA sites at post-intervention year 2. The results of this QI project will inform further refinements to VHA's efforts to implement HRO principles and practices in the nation's largest integrated health system. In addition, the implementation practices may inform other large-scale, multi-level efforts to improve quality and patient safety.

Updating the critical steps of the quality implementation framework: a protocol for an umbrella review of reviews

IntroductionImplementation science focuses on improving the dissemination, uptake and adoption of evidence into practice. Over the last decade, implementation science research has proliferated, particularly in healthcare and social science. The...

A scoping review, novel taxonomy and catalogue of implementation frameworks for clinical decision support systems

BackgroundThe primary aim of this scoping review was to synthesise key domains and sub-domains described in existing clinical decision support systems (CDSS) implementation frameworks into a novel taxonomy and demonstrate most-studied and least-studied areas. Secondary objectives were to evaluate the frequency and manner of use of each framework, and catalogue frameworks by implementation stage.MethodsA scoping review of Pubmed, Scopus, Web of Science, PsychInfo and Embase was conducted on 12/01/2022, limited to English language, including 2000–2021. Each framework was categorised as addressing one or multiple stages of implementation: design and development, evaluation, acceptance and integration, and adoption and maintenance. Key parts of each framework were grouped into domains and sub-domains.ResultsOf 3550 titles identified, 58 papers were included. The most-studied implementation stage was acceptance and integration, while the least-studied was design and development. The three main framework uses were: for evaluating adoption, for understanding attitudes toward implementation, and for framework validation. The most frequently used framework was the Consolidated Framework for Implementation Research.ConclusionsMany frameworks have been published to overcome barriers to CDSS implementation and offer guidance towards successful adoption. However, for co-developers, choosing relevant frameworks may be a challenge. A taxonomy of domains addressed by CDSS implementation frameworks is provided, as well as a description of their use, and a catalogue of frameworks listed by the implementation stages they address. Future work should ensure best practices for CDSS design are adequately described, and existing frameworks are well-validated. An emphasis on collaboration between clinician and non-clinician affected parties may help advance the field.

Cosmocnc: A fast, flexible, and accurate framework for galaxy cluster number count likelihood computation

We introduce cosmocnc, a new framework for computing the number count likelihood of galaxy cluster catalogues in a fast, flexible and accurate way. cosmocnc offers three types of likelihoods: an unbinned, a binned, and an extreme value likelihood. It also supports the addition of stacked cluster data, which is modelled consistently with the cluster catalogue. The unbinned likelihood, which is the main focus of the framework, can take an arbitrary number of mass observables as input and deal with several complexities in the data, such as variations in the properties of the cluster observable across the survey footprint, the possibility of different clusters having measurements for different combinations of mass observables, redshift measurement uncertainties, and the presence on unconfirmed detections in the catalogue. If there are more than one mass observables, the unbinned likelihood is computed with a novel approach, the backward convolutional approach. After introducing the framework in detail, we demonstrate its application with synthetic Simons-Observatory-like catalogues, finding excellent agreement between their properties and cosmocnc's predictions and obtaining constraints on cosmological and scaling relation parameters featuring negligible biases. A Python implementation of the cosmocnc framework is publicly available at https://github.com/inigozubeldia/cosmocnc.

Keep it Movin': Design and methods of a church-based physical activity program to improve physical function among midlife and older black adults.

Older Black adults have high rates of physical function (PF) limitations. Physical activity (PA) is effective for improving PF and reducing mobility disability risk; however, community-based PA interventions focused on improving PF for older Black adults are lacking. Given the importance of churches as trusted institutions in Black communities, church-based interventions developed through community collaborations may help increase access to PA interventions. Keep it Movin' is a church-based cluster randomized controlled trial testing the effectiveness of a 24-week group-based (intervention arm) versus a self-guided (comparator arm) program in improving PF among Black adults aged ≥40 years with PF limitations (short physical performance battery [SPPB] score ≤ 9). A church-wide virtual walking program is available to congregants in both arms. The intervention arm receives weekly group-based classes held at the church that include education, goal setting, and structured PA (walking, lower-extremity strength, balance, and stretching). The comparator arm receives educational materials about PA appropriate for people with PF limitations. Outcomes are assessed at 6 (program completion) and 12 months (maintenance). The primary outcome is PF change as measured by the SPPB at 6 months. Secondary outcomes include change in moderate-to-vigorous PA, social support and self-efficacy for PA, quality of life, and self-reported PF. Factors related to successful adoption, implementation, and maintenance are assessed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. This is the first study to evaluate the effectiveness of a group-based PA program delivered in Black churches to improve PF.

Implementing universal maternal depression screening in head start: A convergent mixed methods study

AimsImplementing maternal depression screening in child-serving programs can help ensure that more mothers receive mental health services. This study examined the implementation of universal maternal depression screening in community-based Head Start programs. MethodsQuantitative and qualitative data were merged in a convergent mixed method design to assess four domains from the RE-AIM implementation science framework (Reach, Adoption, Implementation, and Maintenance). Qualitative data included interviews with stakeholders and meeting minutes from the implementation period. Quantitative data included intervention outcomes and administrative data. ResultsIn terms of reach, 85% of eligible Head Start mothers were screened for depression, and English-speaking mothers were more likely to refuse screening than Spanish-speaking or bilingual mothers. Barriers to screening included lack of availability, stigma, privacy concerns, lack of interest, and lack of trust. In terms of adoption, all sites and staff adopted screening due to organizational mandates. In terms of implementation, there was wide variation in rates of positive screenings across staff completing the screening (ranging from 0% to 46%), and barriers included concerns about staff role and lack of training. In terms of maintenance, screening was not sustained after the study period due to organizational priorities and lack of buy-in from staff. ConclusionUniversal maternal depression screening has the potential to reach low-income Head Start mothers, but additional efforts should be made to build staff capacity to engage mothers in screening.

Context Based Ranking Strategies for Renowned Instructional Methodologies

The main objective of this work is to validate the decisions made towards adoption of appropriate instructional methodologies based on the context of a specific region considering the quality of education, the cost of education and the learning outcomes as predominant parameters. The non-deterministic events and uncertain situations that may arise over a long-range period impose a vague and fuzzy environment in the educational system. Investigations have been made to identify suitable educational framework for implementation in the institutions of a specific region in view of these unpredictable events and non-deterministic conditions. Fuzzy decision analysis and rough set theory have been applied to rank the prominent instructional methodologies which are encompassed within each educational framework. Hurwicz Rule is adopted to balance the pessimistic and optimistic opinions about the non-deterministic events while validating the merits of the instructional methodologies. Grey relational analysis is carried out while ranking instructional methodologies in a vague environment. In this work, the instructional methodologies are ranked using fuzzy entropy as well as crisp entropy measures and the outcomes of the fuzzy and rough sets-based decision analysis have been validated.